A Novel Service Design for Remote Transmission of Pacemaker Data St. Mary s General Hospital, Kitchener May 2015

Transcription

1 A Novel Service Design for Remote Transmission of Pacemaker Data St. Mary s General Hospital, Kitchener May 2015

2 Disclosure I have no actual or potential conflict of interest in relation to this presentation

3 Contents Background St Mary s General Hospital RCC Patient Population Volumes Remote Monitoring Methods Objective Service model Implementation Stakeholder Engagement Results Evaluation Key Success Factors Next Steps Key considerations

4 St. Mary s General Hospital 150 acute care bed community hospital located in Kitchener, ON Home to the Regional Cardiac Care Centre (RCCC) for Waterloo Wellington Has provided a full range of cardiac services including device insertions since

5 SMGH Pacemaker Patient 2577 patients ~60/40 M/F Average age 77 (2009: 73) 67% of patients live outside of Kitchener Waterloo. Highest concentration of patients in Guelph, Cambridge, Stratford, Brampton, Woodstock

6 Appointment Volumes Device Clinic Visits Device Clinic Visits Year over Year Average Annual Growth Rate 15% (Conservative) Year over Year Average Annual Growth Rate 15% (Conservative) First yr. recorded: 2010/ % growth projected ~5300 visits ICDs Pacemakers Follow up Schedule:: 72 hrs after insertion, 6 months, 1 yr-,very 3, 2, 1 month until replacement In comparable clinics/patient population 95% of visits are for routine followup, 82 % require no programming (Allen, 2014) Allen, S. (2014). Remote follow Up: where are we now? Has it improved patient services? Retrieved from Remote%20Follow%20Up,%20S%20Allen.pdf

7 Remote Monitoring of Cardiac Devices Wilcoff, B. & Slotwiner, D., Cost Efficiency and Reimbursement for Remote Monitoring: A US Perspective, Europace (2013). Benefits cited: patient convenience, with reduced use of office services equal safety compared with in person evaluation a relative reduction in the risk of death shorter detection time to actionable events (arrhythmias, cardiovascular disease progression, and device malfunction) increased battery longevity

8 Objective To assess the feasibility of offering patients who need routine pacemaker device checks the opportunity to transmit data remotely from a satellite site in the Guelph region Key factors: Not all pacemaker patients candidates for continuous home monitoring Availability of Medtronic CareLink Express (un paired) currently used primarily in EDs

9 Service Model Patient enrolled in service at device insertion Given remote & in clinic appointments Visit site in their community to transmit data Data read in clinic within 24 hrs (Carelink portal) Patient called/report sent to physician

10 Implementation: PDSA Cycle 1. Work with patients, caregivers and clinic staff to design model 2. Identify those patients from the Guelph region who would benefit from/are eligible for remote monitoring 3. Monthly sessions then increase frequency to weekly (rapid feedback) Plan (Heavier on 1 st cycle) Act Adjust process Adjust projections KT Celebrate Success Do Satellite Clinic Design/Feedback sessions Check Measure impact on: PE/Quality Workflow/Process Resource use

11 Service Design Stakeholder Engagement Process Solicited feedback and evaluation on an on going basis Met with small groups of patients, caregivers & community interest groups in Guelph Discussed/mapped service from patient point of view (Experience based Design method) Solicited feedback and suggestions on location Consulted with GGH Transition steering group Patient & Caregiver priorities (must haves/good to haves): Ease of access Free parking Was not important to them that the service be based at a medical facility

12 Kiosk Remote Service Model ~200 patients using service Location: YMCA of Guelph 1 st session May 26 th, 2014 Now held every Monday afternoon Average session length: 7 min Patients supported on site by volunteers Volunteers recruited through partnership with St. Joseph s, Guelph. Screened by SMGH.

13 Evaluation No adverse clinical events Patient Experience: 95% of participants strongly agree that they would continue to use the service, Improved attendance for Guelph patients who were no shows at the clinic Methods: Baseline in clinic survey and anonymous mailed post session Clinic Efficiency: Service requires ~50% less resource time per visit, and has the potential to offset increase in in clinic appointment volumes if scaled Methods: Time study conducted in clinic and following implementation (2x) Value for Money: No direct overhead YMCA partnership Volunteers assist patients on site However Reimbursement levels not established by MOHLTC for Remote Monitoring services for pacemaker patients. :

14 Key Success Factors & Barriers Patient Pull & engagement Executive attention Partnerships Clinical champion Real time evaluation Reimbursement Availability of data Standards of Care/Evidence

15 Next Steps Scale? Improve In clinic flow? Statusquo?

16 Key Considerations Funding needed to off set lack of reimbursement once threshold volume is met/clinic operations are optimized Assessment of need (volumes, patient population) Opportunity to scale through existing partnerships Integrate fully into standard of care

17 Questions? Contact: Kim Siegel, Dir. RCC